There is no doubt we need to be careful and cautious with labels. And comparing The Holocaust (as Peter Kinderman did) to anything other than another systematic and extensive act of genocide trivializes the former and reduces whatever criticism was intended of the target to a nasty school yard epithet. It is just plain thoughtless, stupid, and insensitive – as James Coyne pointed out.

But the concept of disease is just that, a concept. The word itself is a conjunction of “dis” and “ease”. The modern concept of disease has a two or three hundred-year history. And it is, after all, the very concept that allowed us to eradicate – well, almost eradicate – measles, mumps, polio, diphtheria, cholera, to treat some cancers, heart disease, pneumonia, and to improve the lives of those suffering from the conditions of bipolar disorder, depression, and schizophrenia.

We have philosophical and scientific approaches to the concept of disease, and folk definitions. These may invoke evolution, constructivism, objectivism, adaptation, and concepts of “abnormal” and “normal”. And “normal” itself, can entail ideas of function, value, ideals, averages, and adaptation, as well as bell curves, actuarial tables, standard deviations.

The concept of disease does also imply a biological insult, difference, or malfunction of some sort, from its history of scientifically seeking cause and effect and the linkages between them, of leaving older explanatory concepts of magic, karma, miasma, destiny, god, evil, the devil and possession behind, to say nothing of the wholly unfounded notion that a “refrigerator mother” can cause autism or psychosis in her child.

We do have a recent history of overusing the disease concept in our modern world, of allowing flawed ideals and values (and commerce) to inform some of our definitions. But, in truth, it was not the overreaching concept of disease that caused damage, but the laws of the time that allowed abuse to follow. And the abuse, as is usually the case, was of power, not of semantics.

Today, on one side of the coin, we have the advocates for addictions and alcoholism petitioning for those afflictions to be called diseases, and on the other side, certain U.K. psychologists asking that all mental disorders be removed from under the rubric of disease. The former, I’m sure, because the concept of disease does absolve one of some moral responsibility for his or her behaviour, and the latter, I’m sure, because the concept of disease requires a physician to head the team of professional helpers.

But let us bring this down to basics:

We perceive someone to be “badly off.” He may or may not perceive himself to be badly off. We then ask ourselves if the disease concept will be of benefit in this situation. Does the idea of “illness” fit? Is he suffering? Is he causing others to suffer? Folk definitions may be applied at this point: “Call the cops.” “He needs a doctor.” “He seems to be okay, he’s not bothering anybody.” “He needs his medications adjusted.” “He’s just a little eccentric.” “That’s just Joe being Joe.” Or even that contradictory but common conclusion, “What a sick bastard.”

This person is brought to or finds his way to a medical professional. The medical professional asks herself similar questions: “Is he badly off?” “Does he perceive himself to be badly off?” “Is he suffering?” “Is he causing others to suffer?” And, then, “Does the concept of disease offer any help in this situation?”

And there is absolutely no doubt (how could there be any doubt today?), that for those behaviours and experiences, those symptoms and signs and suffering that constitute severe mental and emotional disorders, that fulfill the definitions of schizophrenia, bipolar disorder, severe anxiety disorder, severe depression, the answer is YES, ABSOLUTELY.

Unfortunately calling some conditions a “disease” only serves Big Pharma, since the majority of those trained in the medical field will reach for the prescription pad before one can utter the second syllable of the word. Baked beans? The medicalization of normal emotions is, indeed, a lot of gas.

Thanks David for your appropriate evaluation and response. The only thing I would add is we should take off the kid gloves re “Psychologists” who continue to allow an innocent public to not know the difference between “PhD Doctors” and “Medical Doctors” and this needs to be corrected.

Thank you for writing so constructively, and also simply (it makes it easier to engage with as a non-medic), about this topic. A lot of the terms that get thrown back and forth in this race to the top to have voice, and control service provision, seem to be misused, which confuses service-users and the general public; e.g. what is a bio-medical model, is that the same as a medical model, why don’t the people that use it just call it a genetic model when that’s what it is (-this is how distorted beliefs about the psychiatric profession can become, and I cannot see how this serves service-users in any fair way; it’s manipulation). Reasoned posts like this are helpful- I hope that it can get disseminated more widely.

I should have linked this to previous post- this is a major propaganda hub in the UK that uses tactics such as using the personal accounts of individual service-users to sell their cause. http://cepuk.org/ Their conflict of interest page is interesting- it’s focused on the out-group, psychiatry, with no introspection on the in-group… Perhaps cbt doesn’t advocate introspection, who knows

Thank you Dr. Dawson for putting the issues down so clearly. I fear it will not influence the mess yet . The streets are sadly populated with squatters who have not had their diseases in anyway attended to . A dime here and there for food and whatever.